Obesity is a growing problem across the world, by 2030 41% of the global population is projected to be overweight or obese, warns a report. The social costs are staggering, with 2.8 million of a total 59 million deaths per year are tied to obesity. Child obesity, a new WHO report highlights, is also growing fast: in 2014, an estimated 41 million children under 5 years of age were affected by overweight or obesity. Evidence based recommendations to reduce childhood obesity include clear nutrition based labelling, a sugar tax, removal of poor quality food from schools, as well as programmes and urban environments that encourage activity.

The effects of obesity on the development of children can be considerable, and has on numerous occasions been associated with both physical and psychological health consequences during childhood, adolescence and into adulthood. Physically obesity is directly linked to a range of morbidities in childhood, including gastrointestinal, musculoskeletal and orthopaedic complications, sleep apnoea, and the accelerated onset of cardiovascular disease and type-2 diabetes. Psychologically it contributes to behavioural and emotional difficulties, such as depression, and can also lead to stigmatisation and poor socialisation and reduce educational attainment. As obesity becomes a $2 trillion problem, according to an analysis from McKinsey & Company, finding ways to prevent obesity are becoming more and more important for a range of stakeholders.

As a public health issue, childhood obesity often goes under recognised, with childhood obesity in many cases ‘culturally acceptable’. In a new report, titled ‘Ending Childhood Obesity’, the WHO seeks to bring the problem into perspective and recommends possible public policy based interventions that can reduce the immediate and long term consequences of childhood obesity. The study advises societies to create a holistic environment in which children, families, communities and governments work together reduce the incidence of childhood obesity.

Childhood obesityThe level of obesity for children under the age of 5 varies considerably across different regions. Unsurprisingly, some of the world’s poorest countries suffer the lowest incidence of obesity in general; there are some outliers however, with 15% to 20% of children in Egypt overweight or obese, while Libya faces a percentage of more than 20%. Morocco and Tunisia too have relatively high incidences of overweight and obese children. Much of the rest of Africa, outside east sub-Saharan Africa, have an obesity prevalence of less than 5% in children. In the US, Mexico and much of South America, the prevalence of obesity runs at between 5% and 10%. China too belongs to this category, as does Australia.

The research highlights that it is particularly Europe that has high levels of overweight and obesity, averaging nearly 13%. In terms of income levels, across all regions it is particularly the upper middle class that raises obese children, at more than 7%, with the aristocracy slightly more refined in terms of keeping obesity levels in control at around 6%. Children from low income families tend to have the lowest average obesity levels at 4%.

Evidence based recommendationsBased on the synopsis, the WHO makes a range of recommendations. Some of these recommendations are related to regulations regarding how food is labelled as well as tax based incentives to disincentivize foods and drinks associated with the occurrence of obesity in children. Making informed decisions about healthy food choices requires nutrition literacy that is universal and provided in a manner that is useful, understandable and accessible to all members of society. According to the report, moves also need to be made to curb trends in food production – processing, trade, marketing and retailing have contributed to the rise in diet related diseases. The authors recommend that portion sizes are reduced and that a sugar tax should be introduced to disincentive high calorie low nutritional foods and drinks. The sale of high calorie low nutritional food and drink at schools too needs to be tackled effectively.

Recent evidence suggests that obesity, in turn, reduces physical activity, creating a vicious cycle of increasing body fat levels and declining physical activity. Programmes that improve physical activity among children therefore need to be introduced to improve physical activity – in 2010, 81% of adolescents aged 11–17 years were insufficiently physically active – as well as transforming the urban environment to encourage outside activity. Physical activity behaviours across the life-course can be heavily influenced by childhood experience.

Early intervention in good nutrition is also highlighted by the report. Exclusive breastfeeding for the first six months of life, followed by the introduction of appropriate complementary foods, is a significant factor in reducing the risk of obesity. Furthermore, encouraging the intake of a variety of healthy foods, rather than unhealthy, energy-dense, nutrient poor foods and sugar-sweetened beverages, during this critical period supports optimal growth and development. This can be achieved by primary health providers measuring BMI-for-age and enabling them to give appropriate advice to caregivers. Providing a range of support for women during pregnancy is also recommended, with evidence showing that maternal under nutrition (whether global or nutrient-specific), maternal overweight or obesity, excess pregnancy weight gain, maternal hyperglycaemia (including gestational diabetes), smoking or exposure to toxins can increase the likelihood of obesity during infancy and childhood.